BRBPR

The world is divided into those who look at their productions before flushing, and those who push the lever with nary a backward glance. Even though I declared myself a non-discloser in my last post, I must admit I am one of the former. It's just good self-care I think.

What you do NOT want to see is BRB or bright red blood. This BRBPR (that's Per Rectum per MD abbreviations) is alarming, and no further prodding should be needed to visit your MD for prodding. Yesterday was BRBPR day--two women with same, but two different problems.

I've mentioned before my reluctance to examine 'samples' that patients bring me in baggies and bottles, but BRBPR Patient #1 was an exception. These (blood) out-of-body experiences tend to look worse to the bleeder than they really are, so Pt. #1's specimen in a jar was instructive. It was indeed blood--not bits of sun-dried tomatoes--and a fair amount of it at that, deep maroon and mixed in with stool.

Other than this being episode #3 in as many months for her (no alarmist she!), she felt quite well, no pain, no fever, no weight loss, no loss of appetite. Classic story for diverticular bleeding. Diverticula are little intestinal outpouchings that occur commonly in middle-age and beyond. Those of us who are under-fibered and stopped up on Western diets are at particular risk. Mostly asymptomatic, diverticula can become inflamed (diverticulitis) or occasionally hemorrhage. There's no depouching a colonic pouch, however, if they continue to bleed--and they can bleed big-time--the solution is a surgical parting with that part of the colon.

Pt. #2 was also passing BRBPR. She was thankfully sampleless, but her bleeding occurred after she began large doses of ibuprofen for back pain. She developed diarrhea (a known Intestinal complication of ibuprofen) and the blood followed. While diarrhea can cause hemorrhoids to flare-up and bleed, I suspect she will be found to have intestinal ulcerations from the use of this OTC analgesic.